Will I require a revision surgery to fix drooping?

I had my BA on 5.17.17 and am about 4 weeks post op. I had tuberous breasts that were severely asymmetrical. My left was a C and my right was an A. I was scheduled for a benelli mastopexy with cohesive silicone implants (415cc left, 520 cc right) to even them out. Woke up to find no benelli was done and now that breast is still super droopy. I'm terrified it won't even out over time. Will I need more surgery?

ANSWERS FROM DOCTORS (6)


1 week ago by Tim Sayed MD, MBA, FACS

It's possible you might need revision surgery but it is probably too early to tell. I find most tuberous patients need a mastopexy of some sort, at least a Benelli lift, and sometimes a vertical or full anchor, in order to properly position the nipple and to reduce the snoopy bulginess of the nipple-areola complex. It is early for your result and settling of the implant may make the nipple position appear better centered over time. Stay in contact with your surgeon.

1 week ago by Tim Sayed MD, MBA, FACS (View Profile)

It's possible you might need revision surgery but it is probably too early to tell. I find most tuberous patients need a mastopexy of some sort, at least a Benelli lift, and sometimes a vertical or full anchor, in order to properly position the nipple and to reduce the snoopy bulginess of the nipple-areola complex. It is early for your result and settling of the implant may make the nipple position appear better centered over time. Stay in contact with your surgeon.


2 months ago by The Institute of Aesthetic Surgery

It is always important to have a well defined operative plan. Some discussion of potential alterations in this plan should be discussed ahead of time (i.e. "You selected implant "X," should we encounter a problem we can consider implant "Y" which is also available.")

While I am sure your surgeon had a reason for improvising the plan, this potential should have been discussed. That being said, the more important question is how you feel. If you are unhappy, I would reserve judgement until you are further along in your healing process. A final result is often not apparent for 4-6 months post op.

Discuss your concerns with your board certified plastic surgeon, I am certain he/she will do what is necessary to accommodate you (as long as it is within reason).

2 months ago by The Institute of Aesthetic Surgery (View Profile)

It is always important to have a well defined operative plan. Some discussion of potential alterations in this plan should be discussed ahead of time (i.e. "You selected implant "X," should we encounter a problem we can consider implant "Y" which is also available.")

While I am sure your surgeon had a reason for improvising the plan, this potential should have been discussed. That being said, the more important question is how you feel. If you are unhappy, I would reserve judgement until you are further along in your healing process. A final result is often not apparent for 4-6 months post op.

Discuss your concerns with your board certified plastic surgeon, I am certain he/she will do what is necessary to accommodate you (as long as it is within reason).


2 months ago by James D. Wethe, M.D.

OK... the first thing to do is take a deep breath. There clearly was a reason your surgeon decided not to do the mastopexy at the time of the surgery. When you are in for your postop appointment go over that reason with the surgeon. Remember, a mastopexy can always be performed following the augmentation but if your surgeon was not convinced you would need the lift they may have decided to wait for a bit of time to allow settling. Most patients would prefer everything done in one session but, at times, the best option is to wait and make sure you get the best possible symmetry as the end result. Hope this helps.

2 months ago by James D. Wethe, M.D. (View Profile)

OK... the first thing to do is take a deep breath. There clearly was a reason your surgeon decided not to do the mastopexy at the time of the surgery. When you are in for your postop appointment go over that reason with the surgeon. Remember, a mastopexy can always be performed following the augmentation but if your surgeon was not convinced you would need the lift they may have decided to wait for a bit of time to allow settling. Most patients would prefer everything done in one session but, at times, the best option is to wait and make sure you get the best possible symmetry as the end result. Hope this helps.


2 months ago by Larry Schlesinger, MD, F.A.C.S.

Thank you for your very interesting question. I had a similar case not too long ago where asymmetric tuberous breasts were involved. On the non-droopy (ptotic) side, a standard perioareolar release and five cuts into the breast tissue allowed the splaying out of the breast over the cohesive (gummy bear) implant. On the ptotic breast, I planned to do a Benelli mastopexy. However, intraoperatively, it became evident, because of the patient's large areola, that the Benelli lift would not leave enough room for her requested implant size. To complicate things, the patient also had a very wide chest and widely separated breasts as is often seen in individuals with bilateral tuberous breasts, and if I put a smaller implant on the ptotic side, I would have to put an equally smaller implant on the smaller side, leading to small breasts on a wide chest. I made the difficult intra operative decision to go with the desired size implants and attempt to correct the ptosis with an implant.

In Type II tuberous breasts, the breast tissue falls over due to a constricted band and no inferior medial or lateral breast tissue. Plastic surgeons often correct this situation by lowering the fold, releasing the constriction of the breast, and using the implant to fill in the inferior medial and lateral aspects of the breast.

All the mumbo jumbo above means that in a Type II tuberous breast, sometimes the perioareolar release of constricted breast plus a subpectoral implant can not only augment the breast, but can also correct the ptosis by correcting the cause of the ptosis, which is lack of the lower pole fullness of the breast. Rather than worrying about a possible second surgery, ask your plastic surgeon to explain why he or she put off the lift and, at what point should the two of you together decide if a second surgery is absolutely necessary. At one month post correction of tuberous breasts, your breast position and shape are still in a dynamic flux, and it may take up to 6 months before you see the final result.

2 months ago by Larry Schlesinger, MD, F.A.C.S. (View Profile)

Thank you for your very interesting question. I had a similar case not too long ago where asymmetric tuberous breasts were involved. On the non-droopy (ptotic) side, a standard perioareolar release and five cuts into the breast tissue allowed the splaying out of the breast over the cohesive (gummy bear) implant. On the ptotic breast, I planned to do a Benelli mastopexy. However, intraoperatively, it became evident, because of the patient's large areola, that the Benelli lift would not leave enough room for her requested implant size. To complicate things, the patient also had a very wide chest and widely separated breasts as is often seen in individuals with bilateral tuberous breasts, and if I put a smaller implant on the ptotic side, I would have to put an equally smaller implant on the smaller side, leading to small breasts on a wide chest. I made the difficult intra operative decision to go with the desired size implants and attempt to correct the ptosis with an implant.

In Type II tuberous breasts, the breast tissue falls over due to a constricted band and no inferior medial or lateral breast tissue. Plastic surgeons often correct this situation by lowering the fold, releasing the constriction of the breast, and using the implant to fill in the inferior medial and lateral aspects of the breast.

All the mumbo jumbo above means that in a Type II tuberous breast, sometimes the perioareolar release of constricted breast plus a subpectoral implant can not only augment the breast, but can also correct the ptosis by correcting the cause of the ptosis, which is lack of the lower pole fullness of the breast. Rather than worrying about a possible second surgery, ask your plastic surgeon to explain why he or she put off the lift and, at what point should the two of you together decide if a second surgery is absolutely necessary. At one month post correction of tuberous breasts, your breast position and shape are still in a dynamic flux, and it may take up to 6 months before you see the final result.


2 months ago by Tom Pousti, M.D.

I am sorry to hear about your concerns after surgery.
I ask patients to allow three to six months before determining if additional surgery is necessary. Continue your follow-up with your surgeon.
If after full recovery you still have concerns, discuss your concerns and options for improvement with your doctor.

Best wishes

Tom Pousti MD
www.PoustiPlasticSurgery.com
619-466-8851

2 months ago by Tom Pousti, M.D. (View Profile)

I am sorry to hear about your concerns after surgery.
I ask patients to allow three to six months before determining if additional surgery is necessary. Continue your follow-up with your surgeon.
If after full recovery you still have concerns, discuss your concerns and options for improvement with your doctor.

Best wishes

Tom Pousti MD
www.PoustiPlasticSurgery.com
619-466-8851


2 months ago by Stephen Greenberg, MD

Thank you for your question.

In the absence of pre-operative and post-operative photos it is difficult to say whether or not a mastopexy was or will still be necessary. Did you speak with your operating surgeon to ask why the benelli mastopexy was not performed? It may be possible that at the time of your surgery the implant selection appeared to address your natural asymmetry and ptosis, and your surgeon felt that the lift was not necessary. While this may sound odd considering the current (still droopy) appearance of your breasts it is important to note that it takes a patient months to see what their surgeon saw in the OR. It takes 3-4 months for your implants to settle and drop.

Please follow up with your operating surgeon to address your concerns. Unfortunately, patience is all I can recommend at this time.

2 months ago by Stephen Greenberg, MD (View Profile)

Thank you for your question.

In the absence of pre-operative and post-operative photos it is difficult to say whether or not a mastopexy was or will still be necessary. Did you speak with your operating surgeon to ask why the benelli mastopexy was not performed? It may be possible that at the time of your surgery the implant selection appeared to address your natural asymmetry and ptosis, and your surgeon felt that the lift was not necessary. While this may sound odd considering the current (still droopy) appearance of your breasts it is important to note that it takes a patient months to see what their surgeon saw in the OR. It takes 3-4 months for your implants to settle and drop.

Please follow up with your operating surgeon to address your concerns. Unfortunately, patience is all I can recommend at this time.


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